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1.
Pediatr Emerg Care ; 38(1): e143-e146, 2022 Jan 01.
Article in English | MEDLINE | ID: mdl-33170569

ABSTRACT

OBJECTIVES: Isolated intraperitoneal free fluid (IIFF) is defined as intraperitoneal fluid seen on computed tomography (CT) without identifiable injury. In a hemodynamically stable patient, this finding creates a challenge for physicians regarding the next steps in management because the clinical significance of this fluid is not completely understood. We hypothesized that pediatric blunt trauma patients with a finding of simple IIFF on CT would not have clinically significant intraabdominal injury. METHODS: A retrospective review (2009-2018) was conducted of all pediatric blunt trauma patients who underwent CT scan of the abdomen/pelvis at our institution. All patients with scans performed at our institution with the finding of IIFF were included. Scans were reviewed to measure the Hounsfield Units (HU) of the intraabdominal fluid. Groups were stratified into HU > 25 and HU ≤ 25, below accepted cutoffs for acute blood, and clinical outcomes were reviewed. RESULTS: A total of 413 patients had free fluid on CT abdomen/pelvis with 279 (68%) having only the finding of IIFF. The HU was 25 or less in 236 (85%) patients. No patients in the HU ≤ 25 group required operative exploration or had examination findings to indicate they had intraabdominal injury. Four (9%) patients in the HU > 25 required laparotomy (P < 0.0001). No patients in the HU ≤ 25 group required further workup or hospital admission over concern for intraabdominal injury. CONCLUSIONS: Pediatric blunt trauma patients with HU of 25 or less IIFF and a nonperitonitic physical examination did not require operative exploration or further workup for intraabdominal injury. In the absence of other injuries, it is safe to discharge these patients without further workup.


Subject(s)
Abdominal Injuries , Wounds, Nonpenetrating , Abdominal Injuries/diagnostic imaging , Abdominal Injuries/surgery , Child , Humans , Laparotomy , Retrospective Studies , Tomography, X-Ray Computed , Wounds, Nonpenetrating/diagnostic imaging , Wounds, Nonpenetrating/surgery
2.
Coluna/Columna ; 19(3): 189-193, July-Sept. 2020. tab, graf
Article in English | LILACS | ID: biblio-1133571

ABSTRACT

ABSTRACT Objective To compare the use of a dynamic surgical guide (PediGuard®) and pilot hole preparation, with the use of a probe and the aid of fluoroscopy in osteoporotic or osteopenic patients undergoing pedicular fixation of the thoracic or lumbar spine. Methods One hundred and eight patients were randomized. A pilot hole was prepared with the dynamic surgical guide (PediGuard®), or with a probe with the aid of fluoroscopy. A total of 657 vertebral pedicles (120 thoracic and 180 lumbar) were included in the study. The parameters used for the comparison were: accuracy of the pedicular screw, number of fluoroscopic shots, and change in intraoperative trajectory of the perforation after detecting pedicle wall rupture. Results In the group with use of the dynamic surgical guide, malpositioning of the pedicle screws was observed in 8 (2.6%) patients and intraoperative change of perforation trajectory in 12 (4%) patients, and there were 52 fluoroscopic shots. In the group without use of the dynamic surgical guide (PediGuard®), misplacement of the pedicle screws was observed in 33 (11%) patients and intraoperative change of perforation trajectory in 47 (13.2%) patients, and there were 136 fluoroscopic shots. Conclusion The use of the dynamic surgical guide (PediGuard®) in patients with osteoporosis or osteopenia enabled more accurate placement of pedicular screws, with less change in the intraoperative course of the perforation and less intraoperative radiation. Level of Evidence II; Randomized clinical trial of lesser quality.


RESUMO Objetivo Comparar o uso de um guia cirúrgico dinâmico (PediGuard®) e o preparo de orifício piloto com uma sonda e o auxílio de fluoroscopia em pacientes com osteopenia ou osteoporose submetidos à fixação pedicular da coluna torácica ou lombar. Métodos Cento e oito pacientes foram randomizados. Um orifício piloto foi preparado com o guia cirúrgico dinâmico (PediGuard®) ou com uma sonda com auxílio de fluoroscopia. Foram incluídos no estudo 657 pedículos vertebrais (120 torácicos e 180 lombares). Os parâmetros usados para a comparação foram: acurácia da colocação do parafuso pedicular, número de disparos fluoroscópicos e mudança da trajetória intraoperatória da perfuração depois da detecção de ruptura da parede do pedículo. Resultados No grupo de pacientes em que se usou o guia cirúrgico dinâmico, observou-se mau posicionamento dos parafusos pediculares em oito (2,6%) pacientes e alteração da trajetória intraoperatória da perfuração em 12 (4%) pacientes, com 52 disparos fluoroscópicos. No grupo de pacientes em que o guia cirúrgico dinâmico (PediGuard®) não foi usado o mau posicionamento dos parafusos pediculares foi observado em 33 (11%) pacientes, a mudança intraoperatória da trajetória da perfuração foi vista em 47 (13,2%) pacientes, com 136 disparos fluoroscópicos. Conclusão O uso do guia cirúrgico dinâmico (PediGuard®) em pacientes com osteoporose ou osteopenia permitiu a colocação de parafusos pediculares com maior acurácia, com menor alteração da trajetória intraoperatória da perfuração e menor dose de radiação intraoperatória. Nível de Evidência II; Estudo clínico randomizado de menor qualidade.


RESUMEN Objetivo Comparar el uso de una guía quirúrgica dinámica (PediGuard®) y la preparación del orificio piloto con una sonda y la ayuda de fluoroscopia en pacientes con osteopenia u osteoporosis sometidos a fijación pedicular de la columna torácica o lumbar. Métodos Ciento ocho pacientes fueron asignados aleatoriamente. Se preparó un orificio piloto preparado con la guía quirúrgica dinámica (PediGuard®) o con una sonda con ayuda de fluoroscopia. Se incluyeron en el estudio 657 pedículos vertebrales (120 torácicos y 180 lumbares). Los parámetros utilizados para la comparación fueron: precisión de la colocación del tornillo pedicular, número de disparos del dispositivo de fluoroscopia y cambio en la trayectoria intraoperatoria de la perforación después de la detección de ruptura de la pared del pedículo. Resultados En el grupo de pacientes en el que se utilizó la guía quirúrgica dinámica, se observó mal posicionamiento de los tornillos pediculares en 8 (2,6%) pacientes y cambios de la trayectoria intraoperatoria de la perforación en 12 (4%) pacientes, con 52 disparos del aparato de fluoroscopia. En el grupo de pacientes en los que no se utilizó la guía quirúrgica dinámica (PediGuard®), se observó un mal posicionamiento de los tornillos pediculares en 33 (11%) pacientes, el cambio intraoperatorio de la trayectoria de perforación se observó en 47 (13,2%) pacientes, con 136 disparos fluoroscópicos. Conclusión El uso de la guía quirúrgica dinámica (PediGuard®) en pacientes con osteoporosis u osteopenia permitió la colocación de tornillos pediculares con mayor precisión, menos cambios en la trayectoria intraoperatoria de la perforación y dosis más baja de radiación intraoperatoria. Nivel de Evidencia II; Ensayo clínico aleatorizado de menor calidad.


Subject(s)
Humans , Orifice Valves , Bone Diseases, Metabolic , Bone Screws , Fluoroscopy
3.
Int J Biometeorol ; 64(1): 157-163, 2020 Jan.
Article in English | MEDLINE | ID: mdl-29058080

ABSTRACT

Animal biometeorology (insects excluded) has been part of the International Journal of Biometeorology since its inception in 1958. Over the first 60 years of the journal, 480 animal biometeorology papers were published. Thus, approximately 14% of published papers dealt with animals. Over the first 60 years, data from more than 50 animal species was presented, with the lead authors coming from 48 countries. The two most common species used in animal papers between 1957 and 2016 were cattle (109 papers: 22.7% of all animal papers) and rats (96 papers: 20.0% of all animal papers). Although cattle and rats dominated, the species in the most cited paper (240 citations) was chickens, followed by bird migration (155 citations), and general livestock (118 citations). Overall, five papers exceeded 100 citations, and a further two exceeded 200 citations. In the last decade, 126 animal papers were published (26% of all animal papers). Many of these papers had a focus on livestock production in developing countries especially Brazil.


Subject(s)
Meteorology , Periodicals as Topic , Publications , Animals , Brazil , Cattle , Chickens , Livestock , Rats
4.
J Pediatr ; 189: 201-206.e3, 2017 10.
Article in English | MEDLINE | ID: mdl-28705652

ABSTRACT

OBJECTIVE: To create a valid tool to measure adolescent resilience, and to determine if this tool correlates with current participation in risk behaviors and prior adverse childhood events. STUDY DESIGN: One hundred adolescents were recruited from primary care clinics in New Jersey for this cross-sectional study. A "7Cs tool" was developed to measure resilience using the 7Cs model of resilience. All participants completed the 7Cs tool, the Adverse Childhood Events Survey, and the Health Survey for Adolescents to identify current risk behaviors. Demographic and background data were also collected. To assess the validity of the 7Cs tool, Cronbach alpha, principal factor analysis, Spearman coefficients, and sensitivity analyses were conducted. The χ2 test and ORs were used to determine if any relationships exist between resilience and prior adverse childhood events and risk taking behaviors. RESULTS: Participants ranged from 13 to 21 years old (65% female). Internal consistency was established using Cronbach alpha (0.7). Lower resilience correlated with higher adverse childhood events (P = .008) and Health Survey for Adolescents scores (P < .001). Lower resilience was associated with increased problems in school (OR 2.6; P = .021), drug use (OR 4.0; P = .004), violent behavior (OR 3.7; P = .002), recent depression (OR 5.0; P < .001), and suicidality (OR 4.1; P = .009). Higher resilience was associated with participation in exercise (P = .001) and activities (P = .01). CONCLUSIONS: The 7Cs tool is an internally validated tool that may be used to screen adolescent resilience and guide pediatricians' counseling against risk behaviors. Further studies will evaluate resilience-building interventions based on results from this study.


Subject(s)
Adolescent Behavior/psychology , Adolescent Health , Health Behavior , Resilience, Psychological , Risk-Taking , Adolescent , Cross-Sectional Studies , Female , Health Surveys , Humans , Male , New Jersey , Outpatients , Reproducibility of Results , Young Adult
5.
Coluna/Columna ; 13(3): 210-213, Jul-Sep/2014. tab
Article in English | LILACS | ID: lil-727083

ABSTRACT

OBJECTIVE: To determine the effectiveness of a pedicle probe to anticipate an impending breach and allow redirection during placement of a pilot pedicle hole. METHODS: Purposely four cortical wall sites were drilled: medial and lateral pedicle wall, and lateral and anterior wall of the vertebral body. The surgeon stopped probing when the sound changed, suggesting abutment against the cortical wall ("anticipation" of impending breach). A fluoroscopy image was then obtained. The surgeon then advanced the PediGuard through the cortex until the sound changed, indicating a breach. In the second part of the study three probes were used: 1) DSG (PediGuard) with curved tip with electronics ON; 2) DSG with electronics OFF; 3) standard Lenke probe. After the images were taken, the operating surgeon (blinded to x-rays) was instructed to redirect and continue drilling into the vertebral body. RESULTS: The surgeon accurately anticipated 60 of 75 (80%) of the breaches, 17 of 19 (89%) in the medial pedicle wall. In the second part of the study the DSG with electronics ON was superior to the DSG with electronics OFF as well as the standard Lenke probe (100% vs. 90% vs. 79%, p = 0.0191). CONCLUSION: Successful redirection by passing the pedicle probes into the vertebral body without a breach after anticipation of an impending pedicle wall breach occurred in 100% of the drillings when done with the DSG with the electronics ON vs only 84% when there was no electronic feedback. .


OBJETIVO: Avaliar a efetividade da sonda pedicular para prever a rotura iminente e permitir o redirecionamento durante o posicionamento de orifício piloto no pedículo. MÉTODOS: Intencionalmente, foram feitos quatro orifícios na parede cortical: parede medial e lateral do pedículo e parede lateral e anterior do corpo vertebral. O cirurgião parava a sondagem à mudança do som, que sugeria a proximidade da parede cortical ("previsão" de rotura iminente). A imagem por fluoroscopia era obtida. A seguir, o cirurgião avançava a sonda PediGuard através do osso cortical até a alteração do som, que indicava a rotura. Na segunda parte do estudo foram utilizadas três sondas: GCD (PediGuard) com ponta curva ligada, PediGuard curva desligada e sonda Lenke padrão. Depois que as radiografias eram feitas, o cirurgião (sem ver as imagens) era instruído a redirecionar e a continuar perfurando o corpo vertebral. RESULTADOS: O cirurgião previu com precisão 60 das 75 (80%) roturas, 17 de 19 (89%) na parede medial do pedículo. Na segunda parte do estudo, o guia cirúrgico dinâmico ligado foi superior à desligado, assim como à sonda Lenke padrão (100% vs. 90% vs. 79%, p = 0,0191). CONCLUSÃO: O redirecionamento bem-sucedido da sonda pedicular no interior do corpo vertebral, sem rotura devido à previsão de rotura iminente da parede do pedículo ocorreu em 100% das perfurações com a utilização do o guia cirúrgico dinâmico com o dispositivo ligado, em comparação com 84% das perfurações com o dispositivo desligado. .


OBJETIVO: Evaluar la efectividad de la sonda pedicular para prever la rotura inminente y permitir el redireccionamiento durante el posicionamiento de orificio piloto en el pedículo. MÉTODOS: Intencionalmente, fueron hechos cuatro orificios en la pared cortical: pared medial y lateral del pedículo y pared lateral y anterior del cuerpo vertebral. El cirujano paraba el sondeo al cambiar el sonido, que sugería la proximidad de la pared cortical ("previsión" de rotura inminente). Era obtenida imagen por fluoroscopia. A seguir, el cirujano avanzaba la sonda PediGuard a través del hueso cortical hasta la alteración del sonido, que indicaba la rotura. En la segunda parte del estudio fueron utilizadas tres sondas: ECMT (PediGuard) con punta curva encendida, PediGuard curva apagada y sonda Lenke estándar. Después que las radiografías eran realizadas, el cirujano (sin ver las imágenes) era instruido a redireccionar y a continuar perforando el cuerpo vertebral. RESULTADOS: El cirujano previno con precisión 60 de las 75 (80%) roturas, 17 de 19 (89%) en la pared medial del pedículo. En la segunda parte del estudio, la sonda ECMT encendida fue superior a la apagada, así como a la sonda Lenke estándar (100% vs. 90% vs. 79%, p = 0,0191). CONCLUSIÓN: El redireccionamiento exitoso de la sonda pedicular en el interior del cuerpo vertebral, sin rotura debido a la previsión de rotura inminente de la pared del pedículo ocurrió en 100% de las perforaciones con el uso de la sonda ECMT con el dispositivo encendido, en comparación con 84% de las perforaciones con el dispositivo apagado. .


Subject(s)
Surgical Procedures, Operative/methods , Spinal Fusion/instrumentation , Fluoroscopy , Pedicle Screws
6.
Coluna/Columna ; 12(2): 138-141, 2013. ilus, tab
Article in English | LILACS | ID: lil-680730

ABSTRACT

OBJECTIVE: The purpose of this study is to report the results using PediGuard (electrical conductivity device) to reduce radiation exposure while drilling the pilot hole for pedicle screw placement. METHOD: Eighteen patients diagnosed with a degenerative lumbar spine, that required a posterior spinal fusion. Average age of the patients were 55 ± 12 years. Patients received postoperative CT scans of all screws. Scans were reviewed by an independent reviewer grading 'in' < 2 mm of breach , or 'out' > 2 mm of breach. In a randomized fashion, the surgeon created pilot holes with either his standard technique or by using the PediGuard. Fluoroscopy was used for each drilling as necessary. Once the pilot hole was created, the surgeon inserted titanium screws into the pedicle pilot holes. A total of 78 screws (39 standard probe and 39 PediGuard ) were analyzed. RESULTS: 78 screws (39 standard probe and 39 PediGuard were analyzed. No significant difference in breach rate > 2mm by either method (p=1.000), with one screw out in each group. Fluoroscopy shots averaged 5.2 (range, 0 to 15), average decrease of 2.3 (30%) per screw in the PediGuard group vs. 7.5 (range, 2 to 17) in the standard group (p< .001). CONCLUSION: This trial to assess pedicle probe location within the pedicle and vertebral body showed the number of fluoroscopy shots were reduced by 30%, compared to a standard probe while maintaining a 97.5% screw placement accuracy.


OBJETIVO: Relatar os resultados do uso do dispositivo PediGuard para reduzir a exposição à radiação durante a perfuração do orifício piloto para a colocação do parafuso pedicular. MÉTODOS: Dezoito pacientes com diagnóstico de doença degenerative da coluna lombar e submetidos à artrodese posterior (todos pelo investigador principal [CDC]) foram incluídos no estudo. A idade média dos pacientes era de 55 ± 12 anos. No pós-operatório foi realizada tomografia computadorizada em todos os pacientes para avaliação do posicionamento dos parafusos. Os exames foram revisados por um avaliador independente. Os parafusos foram considerados no interior do pedículo quando o rompimento da cortical era menor que 2mm, e localizados for a quando o rompimento era maior que 2mm. O orificio piloto foi re alizado foi realizado de modo randomizado por meio de sonda ou utilizando o PediGuard, tendo sido utilizada a fluoroscopia quando necessario. Parafusos pediculares de titânio foram utilizados de acordo com a técnica padrão. Foram utilizados 78 parafusos de titânio de acordo com a técnica padrão, 39 parafusos com orificio piloto realizado com sonda e 39 parafusos com orificio piloto realizado com o PediGuard. RESULTADOS: Não houve diferença significativa na taxa de rompimento do pedículo > 2 milímetros por qualquer um dos dois métodos (p = 1,000), tendo sido observado apenas 1 parafuso fora do pedículo vertebral em ambos os grupos. A media da utilização da fluoroscopia foi 5,2 disparos (variando de 0 a 15) por parafuso no grupo PediGuard vs 7,5 (variando de 2 a 17) no grupo em que a sonda foi utilizada (p <0,0001). Foi observada redução média de 2,3 disparos (30%) por parafuso com a utilização do PediGuard. Foram realizados 202 disparos na fluoroscopia no grupo do PediGuard e 293 no grupo padrão. CONCLUSÕES: Neste estudo prospectivo e randomizado foi observado que a utilização do PediGuard para o prepare do orifício piloto reduz os disparos da fluoroscopia em 30% em comparação com a utilização de sonda, mantendo a precisão da colocação do parafuso pedicular em 97,5% das perfurações.


OBJETIVO: La finalidad de este estudio es relatar los resultados al usar PediGuard (dispositivo de diferenciación de conductividad eléctrica) para reducir la exposición a la radiación al perforar el orificio piloto para la colocación de tornillos pediculares. MÉTODO: Dieciocho pacientes con diagnóstico de degeneración de la columna lumbar, que precisaban artrodesis espinal posterior. El promedio de edad de los pacientes fue 55 ± 12 años. Los pacientes fueron sometidos a TC de todos los tornillos después de la cirugía. Las TC fueron analizadas por un revisor independiente y graduadas como 'dentro' < 2 mm de vacío o 'fuera' > 2 mm de vacío. De modo aleatorio, el cirujano creó orificios piloto con su técnica estándar o usando PediGuard. La fluoroscopía fue usada para cada perforación, de acuerdo a la necesidad. Una vez creado el orificio piloto, el cirujano insertó tornillos de titanio en los orificios pediculares pilotos. Fue analizado un total de 78 tornillos (39 con sonda estándar y 39 con PediGuard). RESULTADOS: Fueron analizados setenta y ocho tornillos (39 con sonda estándar y 39 con PediGuard). No fue encontrada diferencia significativa en la tasa de vacíos > 2 mm en ninguno de los métodos (p = 1,000), con un tornillo fuera en cada grupo. Cada inyección de fluoroscopía fue en promedio 5,2 (franja 0 a 15), la reducción media fue 2,3 (30%) por tornillo en el grupo PediGuard en comparación con 7,5 (franja 2 a 17) en el grupo estándar (p < 0,001). CONCLUSIÓN: Este estudio evalúa la ubicación de la sonda pedicular en el interior del pedículo y el cuerpo vertebral mostró que el número de inyecciones de fluoroscopía fue reducido en 30% en comparación con la sonda estándar, al mismo tiempo en que mantuvo la precisión de 97,5% en la colocación del tornillo.


Subject(s)
Humans , Spine/surgery , Arthrodesis , Fluoroscopy , Radiation Exposure , Pedicle Screws
7.
J Neuroimmune Pharmacol ; 5(1): 143-54, 2010 Mar.
Article in English | MEDLINE | ID: mdl-20119853

ABSTRACT

Nociceptin/orphanin FQ (N/OFQ), added in vitro to murine spleen cells in the picomolar range, suppressed antibody formation to sheep red blood cells in a primary and a secondary plaque-forming cell assay. The activity of the peptide was maximal at 10(-12) M, with an asymmetric U-shaped dose-response curve that extended activity to 10(-14) M. Suppression was not blocked by pretreatment with naloxone. Specificity of the suppressive response was shown using affinity-purified rabbit antibodies against two N/OFQ peptides and with a pharmacological antagonist. Antisera against both peptides were active, in a dose-related manner, in neutralizing N/OFQ-mediated immunosuppression, when the peptide was used at concentrations from 10(-12.3) to 10(-11.6) M. In addition, nociceptin given in vivo by osmotic pump for 48 h suppressed the capacity of spleen cells placed ex vivo to make an anti-sheep red blood cell response. These studies show that nociceptin directly inhibits an adaptive immune response, i.e., antibody formation, both in vitro and in vivo.


Subject(s)
Adaptive Immunity/drug effects , Immunosuppressive Agents/pharmacology , Opioid Peptides/pharmacology , Adaptive Immunity/immunology , Animals , Dose-Response Relationship, Drug , Erythrocytes/drug effects , Erythrocytes/immunology , Female , Immune Sera/pharmacology , Immunosuppressive Agents/administration & dosage , Immunosuppressive Agents/antagonists & inhibitors , In Vitro Techniques , Infusions, Subcutaneous , Mice , Mice, Inbred C3H , Naloxone/pharmacology , Narcotic Antagonists/pharmacology , Opioid Peptides/administration & dosage , Opioid Peptides/antagonists & inhibitors , Spleen/drug effects , Spleen/immunology , Nociceptin
8.
Brain Behav Immun ; 22(6): 824-32, 2008 Aug.
Article in English | MEDLINE | ID: mdl-18374539

ABSTRACT

Endomorphin 1 (EM-1) and endomorphin 2 (EM-2) were tested for their capacity to alter immune function. Addition of either of these peptides to murine spleen cells in vitro inhibited antibody formation to sheep red blood cells in a bi-phasic dose dependent manner. Maximal inhibition was achieved at doses in the range of 10(-13) to 10(-15)M. Neither naloxone (general opioid receptor antagonist) nor CTAP (selective mu opioid receptor antagonist) blocked the immunosuppressive effect. To show that there was specificity to the immunosuppressive activity of the peptides, affinity-purified rabbit antibodies were raised against each of the synthetic EM peptides haptenized to KLH and tested for capacity to inhibit immunosuppression. Antibody responses were monitored by a standard solid phase antibody capture ELISA, and antibodies were purified by immunochromatography using the synthetic peptides coupled to a Sepharose 6B resin. Verification of the specificity of affinity-purified antisera was performed by immunodot-blot and solid-phase RIA assays. The antisera specific for both EM-1 and EM-2 neutralized the immunosuppressive effects of their respective peptides in a dose-related manner. Control normal rabbit IgG had no blocking activity on either EM-1 or EM-2. These studies show that the endomorphins are immunomodulatory at ultra-low concentrations, but the data do not support a mechanism involving the mu-opioid receptor.


Subject(s)
Analgesics, Opioid/pharmacology , Antibody Formation/drug effects , Oligopeptides/pharmacology , Analgesics, Opioid/immunology , Animals , Antibodies/immunology , Antibodies/pharmacology , Chromatography, Affinity/methods , Dose-Response Relationship, Drug , Enzyme-Linked Immunosorbent Assay , Female , Immunosuppressive Agents/pharmacology , Male , Mice , Mice, Inbred C3H , Naloxone/pharmacology , Narcotic Antagonists/pharmacology , Oligopeptides/immunology , Opioid Peptides/immunology , Rabbits , Receptors, Opioid, mu/agonists , Receptors, Opioid, mu/antagonists & inhibitors , Spleen/cytology , Spleen/drug effects , Spleen/metabolism
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